Allergic Triad

Aka: Allergic Triad, Aspirin Induced Asthma, Aspirin Allergy, Aspirin Exacerbated Respiratory Disease, Samter's Triad, Samter's Syndrome

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II. Definitions

  1. Allergic Triad (Samter's Triad)
    1. Allergic Constellation centered around Aspirin (or NSAID) allergy or sensitivity
    2. Associated with Nasal Polyps and Eosinophilic Asthma (T2 Asthma)

III. Pathophysiology

  1. Associated with disordered Arachidonic Acid metabolism (cyclooxygenase mediated to inflammatory agents)

IV. Associated Conditions

  1. Aspirin-induced Asthma
  2. Rhinorrhea
  3. Nasal Polyps
  4. Chronic Sinusitis
  5. Conjunctival edema

V. Course

  1. Onset as perennial Vasomotor Rhinitis
  2. Develops into hyperplastic Rhinosinusitis, Nasal Polyps
  3. Asthma is typically severe from onset with frequent exacerbations

VI. Causes

  1. Aspirin
  2. Cross-reactivity with NSAIDs
    1. Indomethacin
    2. Naproxen
    3. Ibuprofen
    4. Fenoprofen
    5. Mefenamic Acid
    6. Phenylbutazone

VII. Labs: Markers

  1. See Extrinsic Asthma
    1. Associated with increased urinary LTE4 > 166 pg/mgCr
      1. Divekar (2016) J Allergy Clin Immunol Pract 4(4): 665-70 [PubMed]

VIII. Management

  1. Avoid Aspirin and causative NSAIDs above
  2. Use safe alternative Analgesics instead
    1. Salsalate
    2. Acetaminophen
  3. Treat Aspirin-induced Asthma
    1. Leukotriene Modifiers (e.g. Sinulair)

IX. References

  1. Kuruvilla (2019) Clin Rev Allergy Immunol 56(2):219-33 +PMID: 30206782 [PubMed]

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